Introduction Lecture

OSTEOARTHRITIS

Tjok Raka Putra

Rheumatology Div.
Internal Medicine Dept., FK UNUD/RSUP Sanglah
2011
Daftar Pustaka
1. Harrisons
Principle of Internal Medicine
2. Buku Ajar Ilmu Penyakit dalam PAPDI

3. Primer on Rheumatic Diseases, Arthritis

Foundation
4. Pedoman Diagnosis dan Terapi Penyakit

Dalam, RSUP Denpasar

Joint
Consist of:
1. Joint Tissue
1.1. Synovium
1.2. Joint space
1.3. Cartilage
2. Tissue beyond joint
2.1. Tendon
2.2. Bursa
2.3. Muscle
2.4. Bone
Type of Rheumatic Disease
Hundred types

Hospital Baseline Data

Rheumatoid Non Arthicular (RNA),
Osteoarthritis (OA),
Gout Arthritis or Gout,
Rheumatoid Arthitis (AR),
Low Back Pain (LBP),
Systemic Lupus Eritematosus (SLE),
etc.
 Rheumatic Disease Complaints
1. Joint Associated Complaints
Pain, stiffness, swelling, redness, movement
limitation, sendi bersuara
Complaints Beyond Joints (connective tissue)
2. Complaint from Other Organs
heart, eyes, kidneys, nerves, skin, etc.
3. General Complaints
Fever, weakness, lost of appetite
Supporting Examination
1. Laboratory Examination
Depends on working diagnosis
2. Radiologic Examination
On the main site
3. Joint Fluid Punction
4. Arthroscopy
no. 3 & 4 for diagnostic & therapeutic
 Therapeutic Principals of Rheumatic Ds.

Cause Vanish
the cause

Inflammation Process
Overcome
Inflammation
Process Pathology - Symptoms
Symptomatic
Complication
Management Complication
 Self Assessment
To be able to diagnosed and make
therapeutic planning for OA
Definition
Etiopathogenesis
Pathologic Changes
Clinical Symptoms
Supporting Diagnostic Examination
Diagnosis Criteria
Therapeutic Planning
 OSTEOARTHRITIS
( degeneratifve joint disease / hypertropi artrhtitis )

A. DEFINITION
Osteoarthritis is
joint disease marked
by degeneration of
joint cartilage, bone
edge hyperthropy,
& synovial
membrane changes
Causes
Etiologic Factors: multifactorial

1. Primary OA
1.1. Inherited
1.2. Age (elderly)
1.3. Mechanic (microtrauma)
1.4 Cartilage Biochemical Abnormality

2. Secondary OA
From other disease: trauma, obesity,
congenital disease, infection, hemophylia,
gout, etc.
Pathogenesis
Imbalance between cartilage degradation &
sinthesys

Changes from:
Genetic : gene mutation COl2 A1
Host : elderly, overweight, hormonal
Environment : jobs, exercise
 Cartilage Destruction (primary)

Stimulate cyokines production (IL-1,TNF),

histamine, metaloprotease enzyme

Destroy Cartilage & Synovium

Synovitis (secondary)
 Most Affected Sites
Knee Joint
Pelvic Joint
Vertebrae
Ankle
etc
 Osteoarthritis on the Knee
Knee :
most often affected large joint
osteoarthritis.

Predisposing Factors :
- Joint surface injury
- Miniscus tear
- Unstability of ligament /long
standing pelvic or knee
deformity
 Knee Osteoarthritis Image

Cartilage tear often started

on over bearing site. On
severe cases, joint surface
might lost its cartilage and
underneath bone is able to
be crushed. The
characteristic representation
is overgrowth of the bone
(bone spur)
Normal Joint & Mild Osteoarthritis
 Normal Joint & Osteoarthritis Joint

A. Normal Joint B. Osteoarthritis Joint

Knee OA Complaints

Pain
Decreasing joint movement
Swelling joint (effusion)
Joint & Muscle weakness
Joint stiffness
Decreasing of aerobic capacity
Joint changes
 Physical Examination

Crepitating? Movement detention? Shape changes? Swelling?

Supporting Examination
1. Laboratory Examination
Depends on working diagnosis
2. Radiologic Examination
On the main site
3. Joint Fluid Punction
4. Arthroscopy
no. 3 & 4 for diagnostic & therapeutic
Radiologic Feature of OA
(Knee)
Cartilage
Joint space constriction
Chondrocalcinosis
Focal artikular contour irregularity

Bone
Osteofit
Subchondral Sclerosis
Loose bodies
dll

Surrounding Tissue
Swelling
Connective tissue athropy
Osteoficans myocytic
Ectopic Calcification
Knee Joint Arthroscopy

Joint Surface Fibrilation

Knee OA Diagnosis
Clinical
OA Genu Criteria
(Subcommitte ACR)
1. Knee pain
2. R : Osteofit, with
3. One of :
a. Age > 50 tahun
b. Joint stiffness < 30 mnt
c. Crepitation
OA Management
Objective :
1. Reducing Symptoms
2. Prevent further destruction

Therapeutic Modality
Education
Physical Management Non Medicine
Medicne
Surgery
Education Increasing patients
knowledge about:
What is OA
Etiologic and risks factors
Progression & further
possibilities
Complication
Therapy (medicine / non
medicine)
Activity & exercise
 PROHIBITION
1. Legs position: no bending on knee
joint
2. No running, jogging, jumping
3. No knee bending
( squat, duduk bersila, defecating
using sitting closet)
 SUGGESTION
1. Resting or protecting the affected joint
2. Using supporting devices
3. Way of life
~ good body position
~ do not sit on chair that is too low that
cause body bend over
~ reducing body weight
2. PHYSIOTHERAPY
a. Heat Therapy ( DIATERMI )
hidrokolator, ultrasonic, infrared
parafin bath & warm water bathing
b. Electrostimulation
c. Using supporting devices
~ crutches
~ ortesa ( knee decker )
d. Massage
Supporting Device : ORTESA / KNEE
DECKER
KNEE DECKER
CRUTCHES
CRUTCHES
LOW IMPACT EXERCISE THERAPY
 MEDICINE
1. MEDICINE
Principle: pain killer
~ analgetic : acetaminophen
propoksifen HCl
~ NSAID : indometacine
ibuprofen
2. Asam hyoloronat??
 SURGERY
SURGERY
~ arthroscopy
~ osteotomy angulation
ARTHROSKOPI

Untuk
mengecek
kondisi tulang
rawan
OSTEOTOMY

Cutting
upper tibia
& change
joint angle
JOINT REPLACEMENT